My dad is a neonatologist, meaning he cares for the preemies that are whisked away in incubators before their mothers even have a chance to hold them. It’s a tough job, I’m sure, but rewarding to help many of them make up for lost uterine time and catch up with their eight-pound-at-birth behemoth counterparts. It’s surprising how prospective parents wish for nothing more than a normally developing baby, and how quickly we later decide that we aren’t satisfied just being “normal.” Seeing these babies grow up “normal” must feel good to my dad. He’s done it for 30 years.
Still, when I was in college, and for two years afterward “finding myself” in Central America, he never pushed me to consider medicine. In fact, he seemed rather withdrawn on the subject. Many of my peers share similar stories. Physicians that they shadowed emanated pessimism about the direction of medicine. They trained in a different world where many of them could know almost everything that there was to know about their fields, becoming veritable healthcare cowboys. Many specialists in the ’80s and ’90s were making millions of dollars per year while being their own bosses, and from the stories I’ve heard, insurance would reimburse anything.
It’s not just about the money. Hospital systems, many run by MBAs instead of physicians, are now corporations, with the requisite hierarchy. Doctors have levels of people to answer to. Furthermore, the culture they trained in, which for most was some combination of long hours and tough love, is dying off. For the better, to be sure, but people often have a problem when they are treated a certain way for years and then are scolded for doing the same when they are on top of the heap. Patients are not patients anymore, either, but customers or clients. Doctors are paid in part based on patient’s feedback scores.
None of this is news to anyone. If you spend any amount of time with a doctor or dentist or pharmacist, they’ll talk about it, because it affects us all. Mom and pop pharmacies have been swallowed up by chain stores, and newly minted dentists increasingly sign with corporations or groups with multiple practices. It’s a function of high debt levels and competing with fund-backed conglomerates with deep pockets.
Still, I don’t think that explains the hesitation of many healthcare practitioners to recommend their field to up-and-comers. There was never a time when healthcare, or any career for that matter, remained static. And it is still well-paying and stable, difficult or impossible to outsource (except for when it isn’t), and absolutely necessary. It remains the most reliable way to help your fellow man and get a respectable career out of it. However, for perhaps the first time, there is doubt and uncertainty. Unfortunately, if there’s anything that the type of people healthcare classically attracts don’t handle well, it is uncertainty.
Logical or not, we are all making an educated gamble on our careers. The amount of time and training, the ever increasing costs, and the amount of high level competition is staggering. With all of that stacked against it, healthcare still attracts some of the top minds and hardest workers. Why? Because in recent memory there has never been anything closer to guaranteed success– assurance of purpose, clarity of direction, and significant financial reward. There’s no other way that hundreds of schools could field classes of 100+ students, all in the top 20% of their college classes, who would then pay $30,000+ a year and be almost guaranteed of not making more than $100,000 a year until their thirties.
So now that level of investment remains, except that it is becoming more expensive. But the increasing share of the pie taken by insurance companies, the presence of competition from third party financial backers, as well as the influence of an increasingly unpredictable government, are all cascading out of our favor. If brilliant people are okay with such unpredictability, why now would they choose a guaranteed four-ten years of further education for the promise of comfort, rather than something with less investment but more upside (entrepreneurship, pharma, investment banking come to mind)? I can cut the crap and tell you my honest opinion on the matter–medicine is right for many of us, not for many others. If you’re just interested in getting rich, owning multiple homes, and driving fancy cars, I encourage you to go to business school. Work a few years before getting into an MBA program and then spend those years having fun and traveling with your peers. It’s just too much of a gamble to compete with everyone for the highest paying specialties, and even when you get in, it’s a hard road.
These thoughts tumbled out of my conversations with my dad and multiple other practitioners before I chose dentistry. Of course, I ultimately took the lame duck middle road and did both dental school and med school anyway. I am excited by the plethora of alternative practice models that the uncertainty surrounding our fields encourages. Like the Darwinian evolution we studied so thoroughly on our long path to becoming doctors, the selection process for the healthcare providers of the future is well underway– and it will emphasize creativity and experimentation in addition to the intelligence and diligence we are already known for. Intrepid doctors are already running cash only practices, pitching exclusivity to large companies, or developing concierge medicine services. Each of these strategies avoids the operating costs and profit sharing of dealing with insurance companies, because really, what do they provide to us other than access to a patient population? All we really need to do to get ahead of the game is dream up other ways to put ourselves in front of patients, many of whom are equally upset by how complicated and long winded everything about healthcare is.
Further enlightening reading on the costs of a career in healthcare:
I would love to hear more about how dentists, pharmacists, and doctors are experimenting with ways to take advantage of the pressures in their markets. Please feel free to email me or comment below if you have ideas to share! I’m very much looking forward to witnessing the brilliance to come from a generation of providers willing to embrace uncertainty.